Procedures

Facelift Surgery (Rhytidectomy)

When choosing a plastic surgeon to operate on your face, it is important to keep in mind that a precise and technically advanced operation that provides a natural “not-too-tight” look is usually best. No one wants a tightly-pulled, “wind tunnel,” or unnatural-looking face with unsightly visible scars. Some potential face lift patients are fearful of general anesthesia. Coincidentally, this is what attracts patients to the idea that a “lunchtime,” mini-lift, “Threadlift,” or “Lifestyle Lift” might give good results with local anesthesia, less downtime, bruising, or cost. (As you might guess, this typically falls in the “too-good-to-be-true” category. It should also be noted that as of March 2015, Lifestyle Lift, a national chain of face lift centers, was closing its doors and filing for bankruptcy.)

Our doctors’ goal is not to drastically change appearance, but rather to make the best of each patient’s existing attractive features by creating a natural, more-rested, alert, and more-youthful appearance (that still looks like you). We also strive for results that hold-up well as time and aging continue. This is almost never achievable via small incisions or local anesthesia “brand-name,” trademarked, “quick lift-type,” or mini-facelift operations.

Patients with facial aging are often reluctant to consider face lift surgery, for a multitude of reasons, Some think only wealthy movie stars can afford the best face lift surgery (yet so many seem to have such poor results that prospective patients may think “If this is ‘the best’ then I’m out!”). Others fear the nausea or vomiting associated with general anesthesia, prolonged recovery, or visible scars. This does NOT have to be the case!

What you and every face lift patient wants is lasting improvement without over-tightening, rejuvenation without visible or tell-tale scars, avoidance of distortion of normal anatomy like earlobes or hairlines, and a more refreshed and youthful look without friends and acquaintances asking “What happened to you?”  You probably are already aware of examples from Hollywood, Beverly Hills, or Park Avenue of face lift patients that are over-tightened, over-done, or just plain unnatural. In short, what you really want is what we offer at Minneapolis Plastic Surgery, LTD.—discreet state-of-the-art face lift procedures that can provide stunningly-pleasing improvements in your facial appearance. With nearly invisible scars. With experienced anesthesia protocols (TIVA) that have very minimal nausea or vomiting. And with reasonable cost. Each patient has facial features that may need addressing, from the neck to the chin and jowl areas, the cheeks and cheekbone regions, as well as the eyelids, brows, and forehead. (Nose surgery—rhinoplasty—is another facial feature that may warrant plastic surgical attention, and this too can be combined with face lift surgery if you wish.)

Many of these facial areas can be addressed at one operation, but some patients need or request that only certain areas be improved. Our American Board of Plastic Surgery-certified plastic surgeons will listen to your goals, examine your facial features, and recommend an operative plan to best achieve your optimum outcome. You can decide if all or parts of the surgical options are for you—without pressure or guilt. Your confidentiality is enhanced by our discreet patient care in our nationally-accredited (AAAASF) on-site surgical facility. This section will discuss state-of-the-art face lift surgery. Your results will make you wonder why Minneapolis Plastic Surgery, LTD. is one of the best-kept secrets of cosmetic surgery!

Candidates for Face Lift Surgery

If you find yourself looking in the mirror and pulling your skin upwards to smooth and tighten the jaw line, to decrease the depth of the folds around the nose and mouth, or to minimize the loose skin and fat in the jowls, chin, and under-neck area, you are a potential candidate for face lift surgery.

You should be in good general health, a non-smoker, and not on blood thinners or aspirin. Your family physician will need to perform a pre-operative physical (as with any elective surgical procedure) to ensure you are a suitable candidate for anesthesia and surgery.

Face lift (rhytidectomy–“rhytid = wrinkle; ectomy = removal”) is a surgical operation which smooths and tightens the loose skin and muscles of your face and neck, reducing the most apparent signs of aging or weight loss in these areas and giving you a more rejuvenated and youthful appearance. This operation reduces the depth and severity of the creases from the nose and mouth, the slacking jaw line, and sagging jowls. Excess fat from the neck and chin areas is removed, underlying muscles are tightened, and the skin is redraped (without excessive “pulling” or distortion) on the face and neck. Although a face lift cannot give you a completely new appearance, it can give you a younger, fresher look and have a positive effect on your self-esteem and confidence. Tell-tale signs of poorly-performed face lifts include visible scars, excessive tightness pulling the corners of your mouth, “pixie earlobes,” or distorted or scarred hairlines. Distortion of the tragus or ear canal is often seen in face lift patients whose surgeon tried to conceal this area of the facelift incision (and failed, with commonly-seen distortion of the normal anatomy). Dr. Richard H. Tholen and Dr. Douglas L. Gervais have combined over 45 years of experience in providing innovative face lift procedures tailored to the specific cosmetic concerns of each individual patient, not fads or “name-brand” (too-good-to-be-true) operations that are long on hype and short on results!

Fine lines (“smoker’s lines” or lipstick bleed lines) around the mouth, “crepey” skin around the eyes (“crow’s feet”), or skin surface sun damage are not corrected by face lift surgery (any variety), but these areas of concern can be addressed by other or additional techniques.

Face Lift Techniques

It seems that every few years there is some cosmetic surgeon (often not a fully-trained plastic surgeon) somewhere who is offering a “breakthrough” in face lift surgery—variations in actual face lift operations, such as the “S-lift,” the “Lifestyle-lift,” the “Quicklift,” and mini-face lifts with shorter incisions and supposedly quicker recovery, or, more recently, the ThreadLift™, Featherlift®, Rejuvalift®, or other such barbed-suture techniques. Then there are the procedures that claim facial rejuvenation without surgery such as Thermage®, GentleWaves®, Fotofacial™, and others.  There are also laser procedures that claim results equal to or better than actual face lift surgery, though laser energies can only treat the very top skin layers.  The latter are designed to appeal to those patients who want improvements without surgery, usually because of fears about anesthesia, bad scars, or surgery itself, whereas the former attract those patients who know they require some sort of surgical procedure but are hoping to reduce the scarring, recovery, cost, or risk (and are susceptible to “celebrity spokesperson” advertising).

Unfortunately, these natural “fears” create unrealistic hopes and unsupported expectations that “feed” gullible patients right into those doctors or practices (many of them non-plastic surgeons) that offer “more for less.” We often see those patients later, when their actual experience turns out to have been “less for more” and we are now asked to correct or improve upon what failed elsewhere.

Most intelligent consumers understand that whenever you try to get something for nothing, or more accurately, more improvement for less cost, scarring, recovery, risk, etc., you are generally buying into marketing hype that is long on promise and short on delivery. Yet, in this age of science and innovation, even intelligent consumers can be deceived by procedures or practitioners that use special sutures, “brand-named” proprietary techniques, lasers, LED lights, or pseudo-scientific “snake oil.” Unfortunately, rather than improve the procedure to live up to the promise, what some practitioners do is raise the cost to justify the uniqueness or supposed desirability of the “breakthrough” technique or process, but what is actually enhanced is the feeling of disappointment and loss when the results fail to live up to the hype (and costs)!  Add to this the additional time and expense of correcting or redoing the failed or inadequate procedure, and you can see why reputable surgeons decry those who promise much but deliver little.

At Minneapolis Plastic Surgery, LTD. in Minnesota, we have mastered multiple advanced face lift surgery techniques and continue to refine and redefine what works best and gives the best results for each unique patient’s needs and goals. It’s not that the above-mentioned procedures and techniques don’t work. Each of them does give some degree of improvement with respect to cost, risk, scarring, or recovery time. It’s just that they typically deliver less than desired, hoped for, and paid for, while still requiring surgery, some form of anesthesia (usually less than completely asleep and painless, but touted as “superior”), and more down time than bargained for!

Our belief is that even “minor surgery” is still “real surgery,” and even minimal risks and low cost do not justify doing anything less than the best possible option(s) for your face lift surgery.

In our own evaluation of each of these new technologies or “improvements” in technique, we critically evaluate the details to determine what works and what doesn’t, and what fails to deliver or is just plain risky.  We also strive to implement procedures and protocols that maximize results while limiting touch-up surgery or revisions. Our American Board of Plastic Surgery-certified plastic surgeons have the complete training in plastic surgery that non-plastic surgery-trained “cosmetic surgeons” do not; these doctors may be “board-certified” in specialties that have little or nothing to do with plastic surgery, and their cosmetic surgery training may consist of weekend courses or time with other non-plastic surgeons. ABPS-certified plastic surgeons spend 6-10 years of complete full-time surgery and plastic surgery training after graduation from medical school to learn all aspects of plastic and reconstructive surgery, including cosmetic surgery. Many ABPS-certified plastic surgeons, including both Dr. Douglas L. Gervais and Dr. Richard H. Tholen, have taken additional training in facial surgery, breast surgery, laser surgery, and advanced liposuction techniques beyond their complete plastic surgical fellowship and American Board of Plastic Surgery certification.

Being Board-certified in specialties other than Plastic Surgery does not guarantee training, competence, or expertise in cosmetic surgery, though it is “legal” for doctors with other training to perform operations for which they may have little or no formal training! Click for more information about Board Certification in Plastic Surgery and its importance.

We would encourage you to see one of our ABPS-certified plastic surgeons for a complimentary face lift consultation to discuss your wishes, your ideas, and anything you may have heard elsewhere. With a combined 45 years of cosmetic surgery experience in the Minneapolis / St. Paul area, Dr. Richard H. Tholen and Dr. Douglas L. Gervais are absolutely comfortable discussing the pros and cons of each and every option, including our own surgical recommendations, during your consultation. Should you choose face lift surgery, you will receive treatment based on individualized examination and expert assessment. Our reputation has been earned with patient-by-patient results, referral by colleague physicians and previous patients, and actual results that both surgeon and patient can be proud of. Both of our plastic surgeons have been voted (by other metropolitan doctors and nurses) as “Top Doctors” in Plastic Surgery for the regional Minneapolis / St. Paul Magazine.

Procedure

Incisions (and better scars)

Properly-placed face lift incisions are designed to hide in the normal folds and contours around the ear, extending from the scalp near the temple area, around the back of the ear, and then into the scalp high behind the ear to avoid visibility when healed (or when your hair style is “up” or in a ponytail). Since all incisions create permanent scars, choosing incision placement carefully is the first step in achieving a superior facelift result.

We frequently see facelift patients from other practices where incision placement creates permanent scars that are visible on the neck behind the ears, and extend along the lower hairline. Less-than-precise suture technique can also leave depigmented (white) wide scars with visible crosshatch marks, distorted earlobes, and blunted, pulled-forward tragi (the small cartilage bump in front of the ear canals). These are all avoidable!

Deep layer support (better and longer-lasting results)

Support for the underlying facial muscles is not achieved by suturing the cheek skin to the earlobe, as this mobile structure cannot anchor or support tension from the skin or deep tissues. This type of poorly-designed face lift closure pulls the earlobe forward and abnormally low, leaving a widened visible scar in front of the earlobe, as well as an unnaturally-pulled “pixie” earlobe. Careful attachment of the deep tissues to the temporal and mastoid fascia with soft, non-dissolving sutures not only gives long-lasting deep tissue support and lifting, but also allows healing of the skin incisions without tension and with the least-visible scars. We also preserve the normal tragal anatomy in front of the ear canal, avoiding blunting and scarring that are “tip-offs” of having had a (suboptimal) face lift!

Our face lift procedures do not just tighten skin only—the deeper tissue layers are also tightened as described above, using soft, non-dissolving sutures to secure the  SMAS (Superficial Musculo-Aponeurotic System—or the fascia that covers the facial muscles) and the platysma (neck muscle) fascia to the temporal and mastoid fascias respectively. These deep, dual-plane sutures produce less tension on the skin flaps, increase longevity of the cosmetic improvement (how long the face lift “lasts”), and reduce tension on the skin closure, reducing visible scarring. Though many surgeons will tell you that “skin-only” face lifts are “just as good” as dual-plane or SMAS face lifts, there are several studies in the peer-reviewed plastic surgical literature that refute this erroneous claim. Skillfully-placed deep sutures don’t add much in the way of risk or time expenditure at the time of surgery, but can yield major improvements in the quality of the overall result, not to mention how long it lasts! Since every patient’s skin elasticity and collagen content is different (as well as their genetics of healing and scarring), every patient’s face lift results will “last” for differing periods of time–precisely why it is so important to maximize that length of time via the enhanced techniques that we utilize at MPS.

Tissue glue–(less bleeding and bruising lead to faster recovery)

One of the newest innovations in face lift procedures at Minneapolis Plastic Surgery, LTD. involves the use of topical thrombin human fibrin sealant (“natural tissue glue”) to adhere the facial skin flaps to the underlying deeper tissues after they have been lifted and rejuvenated. Use of this product helps speed healing by eliminating the potential space under the facial skin flaps where blood or fluid can accumulate. Less bruising, swelling, and firmness in the healing tissues are noted, and we have been excited to see better results more quickly after surgery.

Refinement under the chin–(smoother jawline and neck area)

A small incision under the chin allows the fat in this area to be removed and the underlying neck muscles to be tightened, rejuvenating one of the most important areas to be addressed in the face lift/neck lift patient.  Every face lift patient will have his or her neck area treated at the same time as face lift; in some patients this is the main area of concern. Isolated neck lift (Platysmaplasty), or lower facelift procedures can be performed in selected patients as appropriate. Another “Oh, you had a face lift” giveaway is incision placement that changes or interrupts hairlines or hair growth.  Careful planning, exact incision placement, and precision closure techniques can keep tell-tale scars or hairline alterations to a minimum, allowing short or “up” hairstyles to be worn rather than forcing you to always wear your hair down or long to hide scars.  Additional considerations are made for men who request face lift/neck lift procedures, as their shorter hairstyles and beard/sideburn growth needs to be considered also.

Short-incision options–(when a “full face lift” is not needed)

At Minneapolis Plastic Surgery, LTD. we do offer short- or limited-incision face lift techniques that work (including mini-lifts, MACS lifts, platysmaplasty, temporal lift, as well as cheek and chin implants), and we continue to evaluate and determine what can be safely and effectively done to reduce scars, healing time, or costs.

Recovery and Results

After face lift surgery you may have one or more tiny drain tubes placed to allow fluid or blood to escape from under the skin, helping the tissue glue give you a smoother, less-bruised result. A well-padded bandage will also help to support your face for a day or two. The bandage and tubes are removed by the second day in most cases, when our staff performs a complimentary hair wash and blow dry. After this, you will be fitted with a stylish elastic chin strap to help reduce swelling. Head elevation and avoidance of strenuous activities is critical for two to three weeks after face lift surgery to minimize swelling or bleeding under the skin, which can compromise your results or require re-operation. All sutures are removed by the seventh to tenth day, and most patients are suitable for social contact by two weeks after surgery.

Of course, some swelling or residual bruising may take longer to resolve completely, and scars fade over time. Some numbness is normal, and it improves as healing progresses. This multi-layered approach to muscle layer and skin tightening (the “dual-plane” or SMAS facelift), as well as fatty tissue sculpture, gives a natural, youthful look that lasts as long as possible for each patient, and much longer than all of the “lunchtime lift” or “fast recovery” face lift techniques.

Since face lift surgery is real surgery, there are always risks and the potential for complications. All the years of experience mentioned above do not eliminate the need for care and individual attention to detail, nor do they guarantee a specific result. Since each individual varies in his or her anatomy, physical reactions, and healing abilities, outcomes are never completely predictable. Results are further affected by patient compliance with requirements and recommendations. Sleeping with the head elevated above heart level (a sofa cushion under your mattress works better than trying to stay on two or more pillows) is important for 3 weeks after surgery. You must absolutely avoid aspirin or ibuprofen-containing medications, Aleve™, additional vitamin E (the amount in a daily multivitamin is acceptable), or herbal preparations of any kind for a full two weeks before and after surgery, as these can increase the risk of bleeding requiring re-operation. You must also avoid tobacco or nicotine, including gums, patches, or sprays, for two weeks prior to surgery, as even one cigarette or incident of exposure to secondhand smoke can cause loss of circulation, resulting in dead skin or prolonged dressing changes. In turn, these may necessitate skin grafting or additional surgery, and the chance of achieving the best possible cosmetic result will be lost. Facial nerve damage is very rare and usually temporary, as is infection. Most complications are minor, infrequent, and resolve with proper attention.

Fine lines around the mouth, eyes, or other facial areas can remain partially visible after surgical swelling subsides, and sun damage or skin surface irregularities are not helped by face lift improvement of the deeper tissues and skin. After everything heals, our plastic surgeons may recommend treatment of the topmost layers of your skin to enhance your facial rejuvenation, and may discuss facial peel or laser resurfacing depending on your individual skin characteristics.
Our goal is to provide the most up-to-date, innovative, and proven techniques that will delight our face lift patients, whether they undergo face lift alone, or add forehead (brow) lifting, eyelid surgery, or rhinoplasty (nose surgery).

Cost of Face lift Surgery

A complete face lift/neck lift procedure at Minneapolis Plastic Surgery (without forehead lift or eyelid surgery) takes about 3 ½ hours in our nationally-accredited (AAAASF) on-site surgical facility. Total face lift costs, including professional fees, anesthesia, operating room, and all follow-up visits, are around $11,600. Male face lifts require additional time, surgical details, and more hemostasis (control of bleeding vessels), with costs around $13,400. Adding eyelid, forehead lift, or other procedures will increase operating time and fees accordingly. Total costs are dependent on each patient’s individual goals and anatomy, and the actual operative steps needed to come as close as possible to these goals. Complimentary consultations are available with our American Board of Plastic Surgery-certified plastic surgeons, who have combined over 45 years of face lift surgery experience and who will tailor your facial surgery recommendations to your individual needs. Exact cost quotes are available at the time of complimentary consultation with our ABPS-certified plastic surgeons. Cash discounts and financing options are available.

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